You can enroll in Medicare Part A at 65, or earlier if you have been on Social Security Disability Insurance (SSDI) for 24 months or have end-stage renal disease

The standard age to start Medicare Part A is 65. If you turn 65 on any day of the month, you become may be able to access that month. You do not have to wait until your birthday passes — the month you turn 65 is the month you can enroll.

There are two exceptions. If you have been receiving SSDI for at least 24 months, you become may be able to access at any age. If you have end-stage renal disease (ESRD) requiring dialysis or a transplant, you can enroll regardless of age. These are the only circumstances that lower the age requirement below 65.

Part A covers hospital stays, skilled nursing facility care, hospice, and home health services. It is the hospital insurance piece of Medicare. You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while working — which covers most people who worked full-time in the United States.

Key Takeaways

  • You become may be able to access for Medicare Part A the month you turn 65, regardless of the day of the month your birthday falls.
  • If you have been on SSDI for 24 months or have end-stage renal disease, you can enroll in Part A before age 65.
  • You should enroll during your Initial Enrollment Period, which runs three months before the month you turn 65 through three months after, to avoid late penalties.
  • If you are still working at 65 and have employer health coverage, you may be able to delay Part A enrollment without penalty, but the rules depend on your employer's size.

Your Initial Enrollment Period and why it matters

Your Initial Enrollment Period is a seven-month window: three months before the month you turn 65, the month you turn 65, and three months after. If you turn 65 in June, your period runs from March through September. You should enroll during this window to avoid late penalties.

If you miss this window, you can still enroll later, but you may owe a penalty on your Part A premium for as long as you have Medicare. The penalty is 10 percent of the standard premium for each full year you could have had Part A but did not enroll. This penalty is permanent — it does not go away once you finally sign up.

The exception is if you have creditable coverage — employer health insurance or coverage from a spouse's employer — at the time you turn 65. If your employer has 20 or more employees, you can delay Part A enrollment without penalty as long as you are still employed and covered. Once you leave that job or lose the coverage, you have eight months to enroll without penalty.

How to enroll in Part A at 65

You have three ways to enroll: online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

If you are already receiving Social Security benefits when you turn 65, you are usually enrolled in Part A automatically. You do not need to do anything. Medicare will send you a card in the mail about two weeks before your coverage starts. Check the card to make sure your name and Social Security number are correct.

If you are not yet receiving Social Security, you will need to enroll separately. Have your Social Security number, date of birth, and citizenship or immigration status ready. The process takes about 15 minutes online or by phone. You will receive confirmation and your Medicare card within two weeks.

Enrolling before 65 if you have SSDI or ESRD

If you have been on SSDI for 24 months, you become may be able to access for Medicare automatically. You do not need to enroll — Social Security will add Part A to your account, and you will receive a Medicare card. This happens without any action on your part.

If you have end-stage renal disease, the process is different. You must enroll through Social Security or Medicare directly. Your doctor or dialysis center can tell you when to start the process, which is usually three months before you expect to need dialysis or after a transplant. Call 1-800-MEDICARE or visit your local Social Security office to begin.

The timing matters because Part A coverage for ESRD begins the first day of the month in which you enroll, or the first day of the month after you have been on dialysis for three months, whichever is later. Starting the process early prevents gaps in coverage.

What happens if you delay Part A enrollment

If you miss your Initial Enrollment Period and do not have creditable coverage, you will owe a late penalty. The penalty is 10 percent of the Part A premium for each 12 months you could have had Part A but did not enroll. If the standard Part A premium is $175 per month and you delay two years, your penalty would be 20 percent of that premium for life.

You can enroll during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage begins July 1 of that year. This is much slower than enrolling during your Initial Enrollment Period, when coverage can begin the month you turn 65.

The only way to avoid the penalty is to have had creditable coverage when you turned 65. If you were covered by an employer plan with 20 or more employees, or by a spouse's employer plan, you have eight months after losing that coverage to enroll without penalty.

Part A and continuing to work at 65

You can work past 65 and still enroll in Part A. Working does not delay your may be able to access or change when you should enroll. However, your decision to enroll may affect your Social Security benefits if you have not yet claimed them.

If you are still working and earning above a certain amount, claiming Social Security before your full retirement age will reduce your monthly benefit. This is separate from Medicare enrollment. You can enroll in Part A at 65 without claiming Social Security, and vice versa — the two decisions are independent.

If your employer offers health coverage and you are under 65, you can stay on that plan instead of enrolling in Medicare. Once you leave the job or lose the coverage, you have eight months to enroll in Part A without penalty. Do not wait longer than eight months, or you will owe a late penalty.

Frequently Asked Questions

Do I have to enroll in Part A if I am still working at 65?

No. If you have employer health coverage and your employer has 20 or more employees, you can delay Part A enrollment without penalty. Once you leave that job or lose the coverage, you have eight months to enroll. If your employer has fewer than 20 employees, you should enroll in Part A at 65 to avoid a late penalty.

What if I turn 65 but do not want Medicare yet?

If you have creditable coverage from an employer or spouse's employer, you can delay enrollment. Once you lose that coverage, you have eight months to enroll without penalty. If you do not have creditable coverage and you do not enroll during your Initial Enrollment Period, you will owe a permanent late penalty.

Can I enroll in Part A without enrolling in Part B?

Yes. Part A and Part B are separate. You can enroll in Part A at 65 and delay Part B if you are still working and have employer coverage. However, if you delay Part B, you will owe a late penalty when you do enroll, unless you have creditable coverage from an employer.

What if I was on SSDI and I turn 65 — do I need to do anything?

No. When you turn 65, your SSDI automatically converts to retirement benefits, and your Medicare coverage continues without interruption. You will receive a new Social Security card and Medicare card in the mail. You do not need to enroll or take any action.

Can I enroll in Part A before I turn 65 if I am not on SSDI?

No, unless you have end-stage renal disease. For everyone else, 65 is the earliest age you can enroll. You can enroll during the three months before you turn 65, but coverage will not begin until the month you turn 65.